AB0477 REMISSION AND CLINICAL PATTERNS OF SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) IN SOUTHERN PAKISTAN: RETROSPECTIVE COHORT STUDY
Authors: M. Saeed, A. Pasha, S. H. A. Rizvi, M. Munawar, Z. Abaad Elias, M. I. Shafi, T. Gazdar, M. P. A. Lakhdir
Journal: Annals of the Rheumatic Diseases (2022)

Background SLE is a difficult to treat autoimmune disease due to clinical heterogeneity, unpredictability of disease flares and limited therapeutics. These challenges are worsened in a low-middle income country (LMIC) setting, yet clinical epidemiology from LMIC may have global benefits. Objectives To determine (i) the clinical pattern of SLE and (ii) the effect of SLE severity and treatment regimen on time to remission. Methods A retrospective cohort study of 200 SLE patients’ medical records (Mar 2014 to Mar 2020) from ImmunoCure clinic was conducted. Patients fulfilled American College of Rheumatology criteria 1997 for SLE classification. Inclusion criteria were active SLE disease, as measured by SLEDAI-2K [1]. SLEDAI categories were used as outcome measure: mild (score ≤6), moderate (7-10), severe (&gt;10) to evaluate clinical pattern of SLE. ANA subsets and disease phenotypes were used to describe the clinical pattern in each SLEDAI category. ANA was performed using Immunofluorescence on Human Hep2 cells. ANA subsets were performed using immunoblot from Euroimmun [2]. Statistical analyses were performed using STATA v16.0. Kruskal-Wallis test was used for continuous measures, and Pearson’s chi square test was used to compare categorical variables across SLEDAI severity. Remission status and time to remission was the secondary outcome. Remission was based on DORIS 4 criteria [3]: immunosuppressives (IS) with Prednisolone (Pred) 5mg or 2.5mg and finally off all drugs (Pred 0 and no IS), along with follow up duration &gt; 1-year. Total doses of all drugs were calculated [4]. Survival regression was used, along with Kaplan Maier curve to estimate median remission time (months). Results ANA Speckled pattern is associated with mild to moderate disease (P=0.02). Most frequent antibodies are anti-dsDNA (63%), SSA (24%) and Ku (17.5%). Anti-cardiolipin (aCL) antibodies are significantly associated with severe disease (OR = 3.6, CI: 1.5-8.5, P&lt;0.01). Most common presentations of SLE in this cohort are arthritis (85%), alopecia (53%), anemia (38%), rash (35%) and CNS disease (28%). Nephritis, CNS disease, cytopenias and oral ulcers are significantly associated with severe disease activity (P&lt;0.01). ILD is in 10% of our cohort. Frequency of severe SLE was 47.5%, whereas mild disease was 16.5%. Mean duration of follow up was 41±19 months. For every 1- month increase in duration of follow up, the odds of remission increase by 6% (CI: 1.04-1.09, P&lt;0.05). Clinical remission on treatment (at Pred≤5mg) was successfully achieved in 62% patients. Complete remission (off all IS &amp; Pred) was achieved in 24 patients (14 in severe SLEDAI category) out of 200, with a mean post remission follow-up of 18 ± 15 months. Importantly, no statistical difference was found in SLEDAI category and remission status (p=0.3). However, the hazard of time to remission is 61% (CI: 0.21-0.77, P=0.01) less in severe SLE as compared to mild SLE disease activity (Figure 1). Figure 1. Kaplan Meier curve for remission time in 94 SLE patients followed for &gt;1-year. Conclusion Presence of aCL is associated with severe SLE. Sustained remission is possible even in severe SLE in a LMIC setting if adequate immunosuppression is provided with persistent clinical follow-up. References [1]Gladman DD, Ibañez D, Urowitz MB. (2002) Systemic lupus erythematosus disease activity index 2000. J Rheumatol; 29(2):288-91. [2]Op De Beéck K, Vermeersch P, Verschueren P, Westhovens R, Mariën G, Blockmans D, Bossuyt X. Antinuclear antibody detection by automated multiplex immunoassay in untreated patients at the time of diagnosis. Autoimmun Rev. 2012 Dec;12(2):137-43. [3]van Vollenhoven R, Bertsias G, Doria A. on behalf of The DORIS Task Force, et al. OP0296 The 2021 DORIS definition of remission in SLE – final recommendations from an international task force. Annals of the Rheumatic Diseases 2021;80:181-182. [4]Saeed, M. Total Dose Calculation for DMARDs in Rheumatic Diseases . 2021 2021 [cited 2022; Available from: https://py2.codeskulptor.org/#user49_XBonsa63u5UuW4Z.py Acknowledgements The Authors are grateful to the patients of ImmunoCure. We are also grateful to the staff members, Mr. Aves Ali Kalwar and Mr. Bilal Ahmed, RN for maintaining the medical records that made this research possible. Disclosure of Interests Mohammad Saeed Shareholder of: Partner in ImmunoCure Laboratory which provides auto-antibody testing, Grant/research support from: Partcipation in EULAR 2022 is sponsored by High-Q Pharma, Pakistan, Aneela Pasha: None declared, Syed Hussain Azhar Rizvi: None declared, Maham Munawar: None declared, Zehra Abaad Elias: None declared, Muhammad Irfan Shafi: None declared, Tariq Gazdar Shareholder of: Partner ImmunoCure Laboratory that provides auto-antibody testing for patients., Maryam Pyar Ali Lakhdir: None declared